Doctor bias can lead to low-value interventions

Personal preferences or beliefs can steer clinicians towards continuing to deliver care that robust evidence has shown to confer little or no benefit.

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Doctor bias can lead to low-value interventions

Doctors have been warned to be aware that psychological factors could lead them to suggest medical interventions of little or no value to patients, despite campaigns aimed at eliminating unnecessary tests, treatments and procedures.

University of Queensland Associate Professor Ian Scott, who is Director of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital, said much of everyday clinical decision making was intuitive and could be influenced by bias.

“In most situations this intuition generates the correct decision, but in some circumstances doctors can fall prey to cognitive biases which generate the wrong decision,” Dr Scott said.

“These cognitive biases, or psychological factors that influence thinking, can come from formal education and training and from peer opinion, personal experience, societal norms and from socialising with colleagues.

“These biases are inclinations a person can have based on one’s preferences or beliefs, and can steer clinicians towards continuing to believe in, and deliver, care that robust evidence has shown to confer little or no benefit.

“It may also cause patient harm, or yield marginal benefits at a disproportionately high cost.”

National campaigns such as Choosing Wisely Australia and EVOLVE aim to reduce the frequency of low-value interventions.

In a review of articles on clinical decision-making, Dr Scott has found the effectiveness of such campaigns could be limited by common forms of cognitive bias.

“For example, a clinician might remember the case of patient X who did very well with a particular treatment despite all the odds and then, in future, go on to treat every other patient with a similar presentation in a similar way, even though for many this may not be the most appropriate form of care,” Dr Scott said.

“To take out the bias, the clinician should question whether he or she would expect to see the experience of patient X repeated again based on the law of averages, or was it really a one-off.”

Dr Scott said sharing case studies of what could be seen in hindsight as low-value care with colleagues and disclosing one’s reasoning for such decisions could help expose and reduce cognitive bias, but further research was needed.

The Royal Australasian College of Physicians, the Menzies Centre for Health Policy and NPS MedicineWise collaborated on the review, which is published in the Medical Journal of Australia.